Try In & Wax Up Flashcards
Trial Denture visit number?
Lab step after?
Trial Denture is patient visit number 4
Then do processing and lab remount
What do you confirm in trial denture visit?
because just because we selected and recorded (we did all this in intermaxillary records) it does not mean we got it right
- Occlusal Plane
- Vertical Dimension
- Facebow Registration (PRESERVATION)
- Centric Relation
- Phonetics
- Esthetics
Intermaxillary records vs trial denture
Recording —-> confirming
trial denture check list
VDO? CR? Phonetics? Esthetics? Patient Approval Signature (EDR)
VDO Evaluation
General and what you consider (4 main ones)
Freeway Space –> M sound
Closest Speaking Space
Space of Donders
Inter-ridge space
Freeway space importance in trial denture visit
Helps in verifying VDO
place dots again, swallow, rest, approximate this position and record the VDR and VDO should be 2/3 mm from there
Closest Speaking Space importance in trial denture visit
VDO Evaluation “S”
small space during sibilant sounds
NO CONTACT IN TEETH
adjust B and D
Space of Donders importance in trial denture visit
VDO Evaluation
this is the space that is between the tongue and palate at REST
what happens when VDO is too much or too little in regards to the space of donders
increase in VDO (teeth too tall) —> increases the space of donders
decrease in VDO , decreases space and teeth too narrow or denture base is too thick – patient will have trouble swallowing and not enough room for the tongue
Interridge space importance in trial denture visit
when natural teeth are in occlusion – ridge crests are a MINIMUM OF 12MM apart
what appearance does increased VDO cause?
decreased VDO?
Increased – stretched appearance
Decreased – overclosed appearance
VDO confirmation?
Swallow
estehtics
phonetics
Step by step corrections to decrease VDO with GOOD ESTHETICS AND GOOD RMP
include what areas you do not touch
problem 1a
not A and not C (occlusal plane)
so you need to warm and intrude areas B and D
- raise pin by the amount that you need to raise vertical (C+D now holding vertical)
- warm wax area D and close the articulator
- intrude area B, one side at a time
if esthetics are good what area is okay?
A
if good rmp what areas are okay?
C
what happens when D moves up when trying to decrease vertical
pin begins to touch and A and B may begin to overlap
if overlap? and dont want it? – intrude B until this does not happen
Step by step corrections to decrease VDO (have excess) with GOOD ESTHETICS BUT RMP TOO HIGH
include what areas you do not touch
Problem 1b
Do the same thing but instead of intruding area D you will work with area C
*warm and intrude area B and C
- Check RMP and raise Pin
- Warm wax area C and close articulator
- Intrude area B one side at a time if there is overlap and you do not want this
leave area D alone
DONT TOUCH A
if overlap – will produce incisal guidance and will have to intrude area B one side at a time (so dont loose esthetics)
Step by step corrections to decrease VDO with POOR ESTHETICS AND
include what areas you do not touch
problem 2
make all adjustments in the anterior first ( A and then B)
Then follow up with intruding C or D as needed, depending on whether RMP is OK
- Select the arch and select the side
- Warm wax and intrude area A (or B) ONE SIDE AT A TIME. – so have a reference
- chech posterior – check RMP and if it is not good - adjust C - if okay and D is okay you can RAISE THE PIN
- warm wax , close articulator, intrude C or D and lower
Step by step corrections with insufficient VDO (have to increase) with POOR ESTHETICS OR PHONETICS
include what areas you do not touch
intra oral or extra oral adjustments?
problem 3
IN PATIENT MOUTH
Add to POSTERIOR FIRST to establish VDO then position anteriors as needed
- place wax on occlusal surfaces until at correct vertical
- if RMP is right – placing on D
- check RMP add wax to C or D
- Remove and reset area A – one side at a time
- check RMP, raise pin, warm wax, close articulator, intrude C or D
Why do we make dentures in CR?
Independent of Tooth contact
Clinically discernible
Clinically REPRODUCIBLE
if CR does not match up what do you do first?
take CR on patient again because you dont know if this was exact – so try again
Initial CR?
Confirmed?
Comparison?
Initial = taken with Auluwax without rims touching
Confirmed= INTRA-ORAL check bite with auluwax– teeth must not touch
Comparison –> made with articulator (so bring wax to articulator and make sure it locks in same as on patient intra-orally
if CR does not match up on articulator?
have to REMOUNT – but check on pt. first a few times - rehearse it before re mount
If there is a discrepancy between the CR on articulator and patients mouth?
have to correct it
take a new bite (CR check bite) and remount lower
what to look for in correct CR?
look for even contact in the posterior teeth bilaterally
look for any shift in the record bases when approaching CR
heel interference?
what can cause an incorrect CR?
- recorded CR in intermaxillary records incorrectly
could be anything really
what if CR fits patient but not articulator?
have to remount because what is on the articulator is what is going to lab and when get back will not be right
so re mount so it is identical
how to correct CR?
you need to remount but LOWER ONLY.
- take a new CR intraorally
- invert articulator
- ***key lower denture / auluwax into upper at slightly increased vertical since teeth do not touch
- stabalize
- remount
- auluwax removed and pin adjusted to the correct VDO
gothic arch tracing - general
another method for recording or verifying CR
theory of gothic arch tracing
restricts masticatory forces to a central bearing point in the mouth, creating a fulcrum of support for the mandible
records path of the central bearing point through protrusive and excursions
POINT AT WHICH THESE MOVEMENTS INTERSECT WOULD RECORD CR
Intra-oral tracing assembly can be used on what three things? what does it do on each?
Wax rims - record CR
Wax-up - verify CR
denture – record CR for a clinical remount
plate mounting technique of upper – which one usually on the top?
TRACING PLATE
upper is larger than lower and is selected for size of pt’s arch
*mounted slightly above the plane of occlusion at the correct height to maintian the VDO
plate mounting technique of lower
this one is usually the mounting plate
this one is placed slightly BELOW plane of occlusion using green stick compound
need to use small enough one where the tongue will not interfere – a larger plate may force the tongue out of rest position and upwards which will interfere with the recording of CR
position of the tracing stylus?
top part of the threaded pin that is inserted into the lower plate – it is also called the leveling screw
**it will make slight contact with the upper tracing/striking plate at PREDETERMINED VDO
- next rehearse CR just like you would with wax recording
felt tip ink use in gothic arch tracing
added to the striking plate/ aka tracing on upper to function as a recording medium
markings made by the stylus as patient goes into protrusive and lateral excursions
what is starting point/point of origin in gothic arch tracing
CR – then go into lateral and protrusive movements
tip of arrow in gothic arch?
CR position which is most posterior and is the origin
when is CR confirmed with gothic tracing?
the tracing is repeated and if reproducible – then CR at the VDO is confirmed
Differences between Bite registration for CR and gothic arch
BITE =
- bilateral recording
- @ increased VDO
- two contact areas
- use of Record bases + rims
GOTHIC ARCH:
- central tracing
- 1 contact point – central bearing
- @VDO therefore stay in hinge position without risk of translation
- U/L record bases
clinical note of caution for bite registration vs gothic tracing
bite registration = risk of working at an increased VDO and more prone to go into translation (greater than 3mm) and there is an extra lab step of restoring the rims after remove the auluwax
can cross bites be acceptable in denture occlusion? what about edge to edge?
yes - crossbite
no edge to edge– will result in cheek biting
what is the major problem the majority of time with dentures at tooth try in or insertion?
ANTERIOR OPEN BITE BECAUSE THERE WAS A HEEL INTERFERENCE IN POSTERIOR AREA
which sounds have no or little influence on phonetics
palatal like onion and velar like k G or NG
labial sounds - check
B P M
Labio dental sounds check
F and V
dento alveolar sounds check
Th, T, S, D, N, Z
1 reason we remake dentures?
2 is esthetics are not how pt. wants them
increased vertical
main things at try in / trial denture
esthetics and phonetics
vdo
cr
does it LOOK the way it should?
does it WORK the way it should?
does the PATIENT like the way it looks?
2 signatures you need at trial denture?
faculty and patient
Wax up includes what?
FB preservation and processing
retention is a function of?
- Patient adaption
- polished surface contour
- atmospheric pressure
- adhesion
- cohesion
what maintains lip position?
a properly contoured denture flange
what will an improper denture flange do?
CHANGE lip position so it will alter:
- esthetics
- phonectics
- lip poisiton
what is the shape of denture so lip is not displaced
the denture is concave where the philtrum is concave – following the borders
where is wax up convex
at the borders and free gingival margin (at the collar)
tissue is concave but denture is convex? what do you do to reach equilibrium?
the cheeks will be DISPLACED and the denture WILL MOVE
need to have the tissue be concave and the denture be concave
the overall denture must be what to RETAIN THE DENTURE?
CONCAVE
interdental papilla must be what shape? what does this allow? what happens if it is not?
CONVEX – and it will allow SELF-CLEANSING–and if not then probably cannot floss and food will get trapped
what happens if you have undercutting in the tooth height of contour?
it would cause tongue to lift the denture
max thickness of denture on palate?
2-3 mm - so it will not affect the speech or tongue movement for swallowing
distance away from CEJ and border in wax up?
2-3 mm away
facebow preservation definition
relates the upper denture to the condyle by preserving the facebow registration position on the articulator
so upper tooth impression PRESERVES relation of upper arch to condyles
minimal indentation in facebow preservation will do what>
PREVENT LOCKING
